General Intake Form

Age Range(Required)
Are you a U.S. Citizen?
If no, are you a permanent resident?
Current Living Situation (check one)
Marital Status
Are you a U.S. Veteran?
Have you been convicted of a felony?
or Misdemeanor?
Are you receiving SSI?
Employment Status: (check all that apply)
KAUL Services Needed:
Additional Support Services Needed:
Have you received services from KAUL before?
Are you a registered voter?
How did you hear about KAUL?